It Takes a Team to Close a Case

Dentistry Today


The team members jumped out of their seats and shared high-fives all around the dental office. Celebratory back slaps were exchanged in the treatment area. Elation was the feeling among all team members after their big win in the consult room. This Tennessee-based dental team had already scored 2-for-2 in its “pay today” attempts. That’s right, the first 2 patients this dental team took through Next-Level Practice’s case-closed system not only accepted the entire treatment presented, but signed the treatment agreement and paid in full, utilizing what my team and I refer to as the pay today courtesy (a 5% discount for patients who pay for treatment in advance). After researching payment terms such as accounting courtesy, bookkeeping dis-count, and prepay, we found that using the verbal language of pay today makes a dramatic statistical difference in closing a case.

Photograph by Nathan Zak

Let’s visit this successful practice 48 hours before the celebrations began. This one-doctor-one-hygienist practice was earning $75,000 a month by offering general dentistry, sedation, Invisalign, and aesthetic services. It was successful by many business standards; however, this doctor knew she could do better. Her team, consisting of front office personnel with more than 20 years of experience, a few crackerjack assistants, and a terrific hygienist, all had been successfully trained in the past by several nationally recognized dental consulting firms. Our Next-Level Practice team spent invaluable time getting acquainted with this progressively thinking dental practice, earning its trust, and handling its concerns. Once everyone was 100% on-board and willing to cause action, all the team members got on the “basketball court” as we stood “on the sidelines” watching the practice in motion. Throughout “the game,” my staff pulled team members aside one-by-one to zero-in on their current beliefs, attitudes, and skill sets.
I knew that this team had great potential once I spoke to the treatment coordinator and had asked why the biggest case she’d ever presented was $5,000. She shared her belief that it is the patients’ responsibility to know their own insurance coverage and she did not think they should have to prepay for service before it is delivered. In these one-on-one discoveries, we found additional opportunities for the practice: the hygienist used intraoral pictures on only 20% of patients. Most treatment was presented from the front desk, with a handful of patients in earshot. The doctor always offered options as she rose from her chair, leaving patients with the feeling that they would need to go to dental school themselves in order to make the right decision.
These beliefs and practices are commonplace in most dental offices across the United States, and I’ve recently learned they are basic truths in Canada and the United Kingdom as well. You see, when the world has been doing something the same way for generations, it can be hard to create change. My favorite quote on change is this: “For things to stay the same around here, we have to make ongoing changes.” I am on a mission to positively alter the way dentists do business as usual. It bothers me to see the same recurring problems exist in practice after practice—this resembles insanity. Suffering is optional in dentistry, and there is a way out. You must trust in a philosophy that makes sense to you. If you understand it, secure it within yourself, and engage your team in accepting it, you will win. So will your team and your patients! The following is one possibility for you to shift how you approach your case acceptance system.


Consider that you and your team’s thoughts and beliefs are at the core of it all, and that the source of real change begins between your ears. If your belief is that it cannot be done, then you are limiting yourself, closing the door on possibility, and you might choose to save the time and effort by not reading the rest of this article. If, however, you are tired of feeling that you have to work harder to gain more, or that you do not think you deserve success, I encourage you to stop here and work this through. Get a coach. Work on your core beliefs before taking this on. When you know that you deserve success and prosperity, then take this on. Only at this point will your career become effortless and your practice evolve into a world-class customer service ATM machine, making a real difference to those you serve.
Before we move on from thinking to doing, consider this question: When was the last time you purchased something that you didn’t think you needed, was going to cost you thousands of dollars, take up valuable time, and cause you pain? This closely defines what many doctors currently offer their patients. And, if you think about it, this question hasn’t truly been addressed. Do you ever wonder why patients have become insurance-dependent? Ponder this a bit and create a new world of willingness and passion to conquer this issue—make it your mission. Okay, we’ve now built a solid foundation to allow you to get it done. Let’s begin. First, I will distinguish how to set up your team structure, and then I’ll give you 3 tools that can be implemented right away.


For a scratch-start practice, you must start with a team of three: the front office, assistant, and hygienist. For an existing practice, with one doctor and one hygienist, you will ideally want 2 people in your front office—one who manages time (ap-pointment coordinator) and one who manages money (treatment coordinator). Money and time are commodities that responsible persons must manage proactively throughout the day.
Let’s assume you want to create a million-dollar practice working 4 days a week. To do this, you must produce $5,500 per day—$1,000 for your hygienist and $4,500 for the doctor. This is an accountability system, or what I call the daily primary outcome (DPO) for the appointment coordinator. This team member’s job is to make sure that the schedule is financially productive every day and to eliminate any roller-coaster-type fluctuations. The treatment coordinator then focuses on a DPO to present at least $7,000, achieving an acceptance rate of at least 67%. The hygienist’s DPO is to generate at least $1,000 in daily production and at least $7,000 in treatment for the treatment coordinator to present. Finally, the assistant has a DPO to ensure that the doctor produces at least $4,500 chairside each day. Your practice is now structured to manage with facts rather than emotions. Everyone is now attached to a scoreboard, so they know whether they are winning. And if they are not, then they know they can rally the team around for support. Of course, these numbers can be adjusted to create larger goals for practices with more team members. (Details on this topic can be found in my book, Million Dollar Dentistry).


NextLevel Practice has developed more than 26 tools to help close a case. However, for the purpose of this article, I will focus on 3 primary, no-miss tools used to transform case acceptance in the practices we have worked with. These tools are (1) the patient qualifier, (2) personal motivators, and (3) the CCWare financial options presenter (CareCredit).

The Patient Qualifier

Do you ever find yourself not really knowing how much treatment to present, especially to a new patient? Or maybe an existing patient has brainwashed you into thinking she has no money, even though she just got back from an around-the-world cruise in a first-class cabin, toting a new designer handbag. This little tool may be your big solution. Envision 4 quadrants on a piece of paper that are divided by 2 axes. The X axis represents the range of low trust to high trust, and the Y axis ranges from low dental values to high dental values. Most patients start out in the lower left quadrant: low trust, low dental value. These are the patients who think your purpose, as a dentist, is to acquire the most toys in Tennessee. They are also the ones that want you to pull their teeth instead of restoring them. This is what frustrates most dental teams.
The key to using this tool is to always start in the same place as your patients. If they fall within the lower left quadrant, don’t try to sell them a roundhouse. Build up to it. From the initial phone conversation to the trust exam, make sure you reiterate that you will address their chief complaints. Start thinking beyond just teeth and gums. Expand outside of the office space you usually work in and realize that you are caring for an emotional human being.

Personal Motivators

This brings us to the second tool: personal motivators. Patients buy on why. They want to know why it is that they need what you are recommending and how it will affect their emotional attachments. Many dentists have been presenting dentistry to patients from a logical position: “You need 2 crowns and 3 fillings.” Here lies an immediate problem in using this approach: Those who are receiving the message are listening for “why I need it” and “how it fulfills my highest values.”
Here’s an example: I was listening in on a new-patient interview between a patient and a treatment coordinator. The patient was explaining how he had not visited a dentist in 15 years and that he’s a hardworking cable guy. His medical doctor, who told him he has an infection moving into his throat possibly from his teeth, referred him to the dentist. This patient described that he was getting older and wanted to be around to see his 3 children grow up. He also shared that he had confided in his wife that he was going to the dentist to have his missing tooth fixed. His wife had told him that she noticed he really hadn’t smiled since losing his tooth. His smile was one of the things his wife loved most about him.
After this patient went to another room for radiographs, I asked the treatment coordinator what she had heard. She said that this patient was typical: he hated the dentist, probably couldn’t afford all the care he needed, and wanted to get that missing tooth fixed to make his wife happy. You see, this treatment coordinator was listening through a filter of brainwashed belief systems, which created her general reality about patients. According to her thoughts, every patient came from the lower left quadrant of the patient qualifier…I decided to transform her belief systems. This treatment coordinator needed to see that this guy was ultimately buying more time with his kids and a reconnection with his wife.
The NextLevel Practice team showed this dental practice how to tie the dentistry (the means) to the emotional ties (the end). As a result, this patient walked out a $15,000 pay today patient, and I can pretty much guarantee that he will not be breaking any of his future appointments.

CCWare Financial Options Presenter

The final tool that I recommend is the CCWare Financial Options (CareCredit) presentation sheet. It can be found on the resource center of the Web site and downloaded onto your computer. Install this on every computer. We ask treatment coordinators to display intraoral pictures and fill out this worksheet prior to releasing the patient from the treatment room. Once patients understand their recommended treatment and you have tied these needs to their personal motivators, you may then present the associated investments that will be required to accomplish their goals. We refrain from using the dental software presenter because we find that it can be overwhelming and confusing.
The CareCredit software makes it easy to present cases and enforces a less-is-more mindset. I particularly like the language that is used in this form. I train coordinators to say, “Your total investment is…” instead of “Your cost is…” I also prefer saying, “Your responsibility is…” instead of “Your out-of-pocket is…” You can also enter the utilities option on this worksheet and change the words accounting courtesy to pay today courtesy. The real genius behind this tool is that it calculates the “pay today” and shows patients the final total. It lends more value for patients to see the discounted figure versus telling them you’ll give them a 5% discount.
People with money tend to love saving their money. For those who purchase in monthly increments to fit their budget, use the 3, 6, 12 interest-free plan, where the doctor pays the interest. This can melt a $5,000 case down to a $333 monthly payment for 12 months after insurance. Most teams never give patients a chance to agree to a $333 easily doable monthly payment. Either they didn’t qualify them, or they neglected to tie the treatment to those patients’ highest values that would drive them to take action. Lastly, many teams rely on old-school case presentation sheets that do a great job of overwhelming patients, and as a result treatment is not accepted.


It takes a team to close a case. So spur your team members onto the court, give them the fundamentals, and everyone will win. Every day you can play an exciting game. It will feel like you’re winning the NCAA of dentistry with slam dunks, chest bumps, and high-fives all around!

Mr. Kadi transforms successful dentists into highly successful dentists: financially secure, professionally respected, and deeply satisfied with their practices and their lives. He created the Next Level methodology and is one of America’s leading dental practice developers. His 12 years of transforming and developing dental practices are captured in his newest book, Million Dollar Dentistry. He can be reached at (480) 361-9955,, or by visiting the Web site